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Individual and Family

The American Rescue Plan's premium-cutting subsidies

Find out how the American Rescue Plan has cut marketplace health insurance costs for Iowans from Des Moines, to Cedar Rapids, Iowa City, and beyond — and how the Inflation Reduction Act has extended those subsidy enhancements. Enroll during open enrollment (November 1 to January 15 in most states) or during a special enrollment period if you experience a qualifying life event.

Learn about the Iowa marketplace

Short-term coverage in Iowa

Consumers in Iowa are able to purchase short-term health plans with initial durations up to 364 days. Read more about short-term coverage options in Iowa.

View short-term plans in Iowa

Medicaid in Iowa

Iowa implemented the ACA's Medicaid eligibility expansion in 2015. Average monthly enrollment in Medicaid plans in Iowa grew by 66% between 2013 and 2022, due mostly to Medicaid expansion and the COVID pandemic. Read more about Medicaid expansion in Iowa.

Learn more about Medicaid in Iowa

Medicare enrollment in Iowa

There were 654,783 Iowa residents enrolled in Medicare as of mid-2022. Read about Medicare coverage options in Iowa.

View our Iowa Medicare enrollment guide

Flexible dental benefits. Fast approval.

Protect yourself from the soaring costs of dental procedures. Compare plan options to see premiums and deductibles that fit your budget.

Compare dental plans in Iowa

Frequently asked questions about health insurance
coverage options in Iowa

Iowa operates a partnership health insurance marketplace with the federal government, which means that residents use the website to compare and purchase individual medical insurance coverage, while the state is responsible for plan management, consumer assistance, and Medicaid eligibility determination.

Read our overview of the Iowa health insurance marketplace.

The open enrollment period for individual/family coverage runs from November 1 to January 15 in Iowa. Outside of open enrollment, a qualifying event is necessary to enroll or make changes to your coverage.

Learn more in our comprehensive guides:

In Iowa, consumers may be able to buy affordable individual and family health insurance by enrolling through the ACA marketplace ( Nearly 90% of consumers who enrolled in 2022 coverage through their state exchange received premium subsidies.

Iowans may also find affordable coverage through Medicaid if they’re eligible. See Medicaid eligibility guidelines in Iowa.

Short-term health insurance is also a lower-cost coverage option in Iowa, where seven insurers offer short-term plans.

There are three insurers that offer exchange plans in Iowa, with plan availability varying from one location to another:

  • Oscar
  • Medica
  • Wellmark

The number of participating exchange insurers increased as of 2021 when Oscar joined, with plans available in Des Moines, Sioux City, Waterloo, and Dubuque.


Overall average rate changes in Iowa’s marketplace amount to a small increase. Two of the insurers are increasing their rates, while the third (which has the majority of the market share) is decreasing its rates slightly:

  • Medica: Overall average rate increase of 9.7%.
  • Wellmark: Overall average rate decrease of 0.9%
  • Oscar: Overall average rate increase of 5%

The Iowa Division of Insurance approved the rates that all three insurers had proposed (details here for Medica and Oscar, and in SERFF filing number WMIA-133287853 for Wellmark).

72,240 people enrolled in private individual market plans through Iowa’s exchange during the open enrollment period for 2022 coverage, which was a record high for Iowa’s exchange.

Off-exchange (directly through the health insurance companies) enrollment in ACA-compliant Iowa health insurance plans had dwindled to almost nothing by 2018, as a result of rising premiums and insurer exits from the marketplace. Although it rebounded slightly in 2019 after rates decreased a bit, enrollment in ACA-compliant plans outside the Iowa health insurance marketplace remains quite low.

But a very significant number of people — about 68,000 — had individual marketplace coverage under grandmothered and grandfathered plans in 2018. And as of 2022, there were still about 34,000 Iowa residents with grandmothered/grandfathered plans.

Iowa is fairly unique in terms of having such a large population on grandmothered and grandfathered plans, relative to their enrollment in ACA-compliant plans.

The ACA’s Consumer Operated and Oriented Plan (CO-OP) Program encourages the creation of nonprofit, consumer-run health insurance issuers. Twenty-four CO-OPs received loans totaling $1.98 billion as of January 2013. CoOportunity Health, which operated in Iowa and Nebraska, received $112.6 million.

But CoOportunity Health stopped selling plans in both states as of late December 2014. It was the first of the nation’s CO-OPs to fail, but almost all of the others failed in 2015 and 2016, leaving just three CO-OPs still operational as of 2022.

Iowa is one of the states that embraced the ACA’s health reforms for the most part, but crucially, the state allowed grandmothered plans to continue to exist in Iowa, and Wellmark didn’t join the exchange until 2017 (and then left at the end of 2017, although they returned as of 2019).

In November 2018, the Iowa Insurance Division reported that about 39,000 people had ACA-compliant individual health insurance marketplace plans in Iowa, while 68,000 people had coverage under grandmothered and grandfathered plans. This is far different from most states, where enrollment in ACA-compliant plans is far greater than enrollment in pre-ACA plans. (Wellmark holds the majority of the state’s pre-ACA enrollment; by 2022, Wellmark’s grandmothered/grandfathered enrollment had dropped to around 34,000 people, which was still very significant relative to the number of people with ACA-compliant individual market coverage in the state.)

But the state’s pre-ACA uninsured rate was relatively low, with a state-partnership exchange and Medicaid expansion in effect since 2014, its uninsured rate continued to drop through 2016, to a low of just 4.3%. The uninsured rate started to rise again in 2017, reaching 4.7%, where it remained in 2018. It crept up to 5% in 2019, but that was still well below the national average of 9.2% at that point.

Premium subsidies in the exchange and Medicaid expansion have made coverage affordable and realistic for many Iowans, but people who purchase their own coverage and aren’t eligible for premium subsidies often find that coverage is entirely unaffordable.

Iowa had the dubious distinction of having the nation’s highest average pre-subsidy premiums in 2018: A staggering $988/month per enrollee, versus a national average of $597/month. Iowa’s average premiums declined in 2019 and 2020, and although they’re still higher than the national average, several other states now have higher average full-price premiums.

Premium subsidies are comensurately large in Iowa, but there’s no relief for people who aren’t eligible for subsidies. That’s a big part of the reason the state began to allow Farm Bureau to sell medically underwritten plans that aren’t regulated by the state as insurance and are thus exempt from ACA rules.

The idea is to allow people to have access to plans that have lower monthly premium costs, but this is only a solution for people who are healthy. Those who aren’t can’t get through the medical underwriting, and have to pay the higher prices that go along with ACA-compliant plans (“you get what you pay for” does ring true here, however, as the ACA-compliant plans provide far more robust coverage, particularly for people who have pre-existing conditions and need benefits that will cover those conditions).

Iowa’s Senators, Chuck Grassley and Joni Ernst, are both Republicans and both are opposed to the ACA. Sen. Both voted yes on all three measures that the Senate considered in 2017 to repeal the ACA (the BCRA, “skinny repeal” and the Obamacare Repeal Reconciliation Act), although all three of those measures failed to pass.

In 2009, Grassley introduced an amendment to the ACA to require members of Congress and their staffs to use the health insurance marketplace – even though the marketplace was intended for individuals and small businesses. The Grassley Amendment was included in the final bill; Congress and their staffers use the DC small business exchange to sign up for health insurance coverage (as opposed to the FEHBP plans that they used to have). Confusion over the amendment led to charges that Congress was exempting itself from Obamacare.

As of 2022, Iowa’s House delegation includes one Democrat and three Republicans.

Former Gov. Terry Branstad, a Republican, was not supportive of the Affordable Care Act. In 2011, Branstad signed Iowa onto Florida’s lawsuit challenging the ACA. Branstad stated a preference for a state-based insurance marketplace, but said the federal government had not provided enough information for Iowa to proceed with that option. Iowa currently operates a state partnership marketplace.

Current Gov. Kim Reynolds, elected in 2016, is also a Republican, and supported the Graham-Cassidy bill to repeal the ACA in 2017 (that measure did not pass). Reynolds expressed disappointment when the state was forced to withdraw its 1332 waiver proposal that would have radically changed the ACA within Iowa. Reynolds won re-election in 2018.

The ACA’s Consumer Operated and Oriented Plan (CO-OP) Program encourages the creation of nonprofit, consumer-run health insurance issuers. Twenty-four CO-OPs received loans totaling $1.98 billion as of January 2013. CoOportunity Health, which operated in Iowa and Nebraska, received $112.6 million.

But CoOportunity Health stopped selling plans in both states as of late December 2014. It was the first of the nation’s CO-OPs to fail, but almost all of the others failed in 2015 and 2016, leaving just three CO-OPs still operational as of 2022.

Iowa is among the majority of the states that have implemented the ACA’s expansion of Medicaid eligibility. The state initially received a waiver from CMS allowing it to take a slightly different approach and still receive federal funding, but that approach was abandoned in 2015 in favor of straight Medicaid expansion coverage as called for in the ACA.

In 2014 and 2015, Iowa’s alternative to ACA Medicaid expansion coverage involved a program called the Iowa Health and Wellness Plan in which residents with household incomes below the federal poverty level were enrolled in a state-run health insurance plan called the Iowa Wellness Plan; some paid modest premiums. Those with incomes of 101 to 138% of the federal poverty level purchased marketplace coverage through a program called the Iowa Marketplace Choice Plan and their premiums were paid by the federal government.

In 2015, the state announced that it would switch to regular Medicaid expansion coverage as outlined in the ACA, and also switch to using Medicaid managed care (as most states do). The switch to managed care took effect in April 2016.

The average monthly enrollment for Iowa Medicaid plans grew by 66% from 2013 through mid-2022.

More information about Iowa Medicaid coverage is available at the Iowa Department of Human Services.

Read more about Medicaid eligibility expansion in Iowa.

Iowa agreed to follow federal rules regarding short-term health insurance plan durations, so plans can have initial terms of up to 364 days and can last for up to three years if they’re renewable.

But the state’s insurance division implemented new rules for short-term health insurance plans in 2019, with restrictions on benefit caps, out-of-pocket limits, and various coverage mandates. The rules are more lenient than the Division had initially proposed in 2018, but more strict than the rules in many other states. As of 2022, the state had approved 364-day plans from seven insurers.

Read more about short-term health insurance coverage in Iowa.

There were 654,783 Iowa residents enrolled in Medicare plans as of mid-2022. Read more about Medicare enrollment in Iowa, including the state’s rules for Medigap plans.

Our guide to Medicare’s open enrollment period for Medicare Advantage plans and Medicare Part D prescription drug plans will provide a variety of useful information to Medicare beneficiaries and their caregivers.

Before the ACA reformed the individual health insurance market, coverage was underwritten in nearly every state, including Iowa. Applicants with pre-existing conditions were often unable to purchase private coverage, or found themselves with very limited options that didn’t cover their pre-existing conditions.

The Iowa Comprehensive Health Association (otherwise known as Health Insurance Plan of Iowa, or HIPIOWA) was established in 1987 to give people an alternative if they weren’t eligible to buy private plans because of their medical history.

Under the ACA, all new health insurance policies became guaranteed issue starting on January 1, 2014. As a result of this reform provision, there is no longer a pressing need for high-risk pools. HIPIOWA is still operational, but membership has steadily declined since 2013.

It’s important to note, however, that Iowa is one of the states that rely on high-risk pool coverage as an option for disabled Medicare beneficiaries under the age of 65 who are not guaranteed access to Medigap plans. Since Iowa does not require Medigap insurers to offer their products to Medicare beneficiaries who aren’t yet 65, it’s important for the high-risk pool to remain operational in order to offer supplemental coverage to these enrollees (Medicare supplement rates through HIPIOWA can be seen here). But as of 2018, there were only 22 members in HIPIOWA’s Medicare supplement plans.

The program had 3,002 members as of Dec. 2013, and just 280 members as of July 2018. Operating costs for HIPIOWA were $11.9 million in 2016. Of that amount, about 30 percent was covered by members’ premiums, and the rest was covered by an assessment on insurance companies operating in Iowa. Premiums are based on 150% of the average premiums charged by the top five insurers in the individual market in the state, although Medica, Wellmark, and Oscar are the only individual market insurer offering plans in Iowa.